Left Ventricular Hypertrophy in Hypertension

Left ventricular hypertrophy (LVH) is a strong risk factor for cardiovascular events. It is present in a substantial percentage of persons with hypertension and accounts for an increased risk for sudden cardiac death, coronary heart disease and heart failure. LVH remodeling patterns are associated with characteristic hemodynamic effects and variable prognosis. Although early studies of LVH relied on electrocardiography, echocardiography is now the clinical and research standard in virtually all studies of left ventricular (LV) structure and function in hypertension and effects of therapeutic intervention. LV mass itself is indexed by some measure of body size to standardize measurement results. Clinical trials evaluating regression of LV mass following treatment of hypertension depend upon accurate test-retest reliability of sonography and reader interpretation. The design of such studies should take into account the diversity of participant demographics, have treatment groups of an adequate size, encompass a study period of at least 1 year to interpret results adequately and have a randomized double-blind design of comparison groups. Regression of LV mass as a surrogate end point for an adverse outcome event in prognostic studies requires evidence of a strong incremental association between LVH and the outcome.